Speed of ED Care Goes Under Quality Microscope

"And we know that patients who spend long amounts of time in the ED have increased numbers of medical errors, delays in getting pain medication, and from a recent paper, we know that patients with heart attacks, when they're diverted from a hospital, have higher mortality...

"We can draw attention to them. We can say look at these numbers. Do they look rational to you, that the average patient spends eight hours in the ED between the time they come in and time they go to the floor? And that some might stay as many as 17? The average person would say that's too long," said Schneider.

She emphasizes that there have been concerns that some hospitals have been, perhaps, a bit too vague in the way they define certain time elements in ED settings. So of course there have been some controversies, and arguments, such as:

How does one define the door?

How do you define the interval of boarding? Shouldn't it end when the patient is placed in a bed?

At what point does a patient brought by paramedics become the responsibility of the ED (at the moment the gurney crosses the threshold, or the time that patient is seen by a physician or triage nurse, or greeter)?

"In some places, the EMS squad might bring a non-critical patient, but may actually wait a half an hour to an hour until room until the ED can accept the patient," Schneider says.

All of these were controversial, Schneider says. But the groups buckled down and came to a compromise.